Intravenous tranexamic acid reduce postoperative drainage and pain after open elbow arthrolysis: a randomized controlled trial

Cui, Hao; Yu, Shiyong; Ruan, Jihao; Sun, Ziyang; Li, Juehong; Chen, Shuai; Fan, Cunyi

doi:10.1016/j.jse.2021.04.031

Cited by 9 publications

(20 citation statements)

References 26 publications

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“…Previous studies [ 23 – 25 ] have shown that TXA could optimize pain control for orthopaedic surgery such as arthroscopic surgery, joint replacement surgery and joint arthrolysis surgery, but there is still controversy about whether TXA increases or decreases pain. The study conducted by Jeffery [ 6 ] showed that topical use may lead to increased local postoperative pain and opioid use.…”

Section: Discussionmentioning

confidence: 99%

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

BMC Musculoskelet Disord

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Background The problem of opioid addiction after total hip arthroplasty (THA) has been widely concerned. Tranexamic acid (TXA) has been shown to be effective in reducing blood loss for patients undergoing THA, but few studies focus on its alleviation of postoperative local pain symptoms. The purpose of this study was to investigate whether topical TXA could reduce early postoperative hip pain for primary THA patients, thereby reducing the use of opioids, and whether local pain is related to inflammatory response. Methods In this prospective randomized controlled study, we randomly divided 161 patients into a topical group (n = 79) and an intravenous group (n = 82). Hip pain was assessed using the visual analogue scale (VAS) score within three days after surgery and tramadol was used for pain relief when necessary. Inflammatory markers such as high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and hemoglobin drop were assessed by hematologic tests. The primary outcomes included the VAS score and dose of tramadol from the first to the third day after surgery. The secondary outcomes included the inflammatory markers level, total blood loss and complications. Results The pain score and inflammation markers level on the first day in the topical TXA group were significantly lower than those in the intravenous TXA group (P < 0.05). The correlation analysis showed that the VAS score on the first day after surgery was positively correlated with the inflammation markers level (P < 0.05). The tramadol dose for topical group was lower than intravenous group on the first and second day after surgery. There were no differences in total blood loss between the two groups (640.60 ± 188.12 ml vs. 634.20 ± 187.85 ml, P = 0.06). There was no difference in the incidence of complications. Conclusion Topical use of TXA could relieve the local pain symptoms and reduce opioid consumption compared with intravenous use for patients undergoing primary THA by reduce the early postoperative inflammatory response. Trial registration The trial was registered at the China Clinical Trial Registry (ChiCTR2100052396) on 10/24/2021.

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Section: Discussionmentioning

confidence: 99%

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

BMC Musculoskelet Disord

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“…There are several other indications for TXA, as it demonstrates reduced blood loss in high tibial osteotomy [48], peri-acetabular osteotomy [49], elbow arthrolysis [50], and spine surgery [51,52,53]. Further research on TXA in orthopaedic surgery should therefore concentrate on administration routes as well as duration of TXA treatment for optimal effect.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

Viberg

2021

Z Orthop Unfall

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Tranexamic acid (TXA) has been studied extensively during the last 5–8 years. It inhibits clot dissolution during surgery and can therefore reduce blood loss. However, there has been concern that this could result in more frequent complications, specifically in terms of thromboembolic events. The indications for TXA are widespread, and this review covers the literature on orthopaedic indications such as joint replacement, fracture surgery, and arthroscopic procedures. In general, TXA is safe and can be used in a wide variety of orthopaedic procedures, lowering blood loss without increasing the risk of complications.

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“…The e cacy of topical and intravenous TXA in orthopedic procedures are the reduction of intraoperative bleeding, transfusion volume, postoperative drain output volume, the score of pain perceived by the patient, and surgery complications. The bene ts mentioned are well systematically documented in the total knee [11,12], hip [13], and shoulder arthroplasty [4,14,15]. Due to the scarcity of evidence to evaluate using TXA in elbow arthrolysis and a few included cases, the e cacy of TXA on elbow arthrolysis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…One of the surgical options for treating elbow contracture is elbow arthrolysis [3]. Achieving effective hemostasis In elbow arthrolysis has the potential to alleviate in ammation and pain, thereby offering potential advantages for the early postoperative rehabilitation of patients undergoing the procedure [4,5]. In fact, when there is bleeding, in ammatory cells migrate to the surgical site and therefore can cause pain, arthro brosis,heterotopic ossi cation or in ammation.…”

Section: Introductionmentioning

confidence: 99%

Does Tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

Nejat,

Khayami,

Daliri

et al. 2023

Preprint

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Background/Objective Effective hemostasis has the potential to reduce inflammation and pain, leading to potential benefits in the early rehabilitation of patients who undergo elbow arthrolysis. In the present study, we aim to assesse the effects of tranexamic acid (TXA) on elbow arthrolysis postoperative blood loss, patients' pain perception according to the visual analog scale (VAS), elbow range of motion (ROM), and complications. Methods We systematically searched PubMed, Web of Science, SCOPUS, and Cochrane Library for studies comparing blood loss between intravenous (IV) TXA and placebo/no treatment. One randomized clinical trial, and three non-randomized clinical trial studies met eligibility criteria. Results The meta-analysis determined that tranexamic acid application reduced drain output 34mm on average (WMD: -34.00 (95% CI: -49.45, -18.55). There was a discrepancy among included articles in terms of intra-operative blood loss; although the study with the largest sample size (291 and 296 patients in the case and control groups, respectively) reported reduced intra-operative blood loss in patients who received TXA. Results for pain intensity, ROM, and complications such as hematoma and ulnar nerve palsy were inconsistent. Conclusion TXA may be beneficial to reduce elbow arthrolysis bleeding volume. However, it dose not seem to affect final elbow ROM and patients’ pain score. Further high-quality clinical trials are needed to draw a robust conclusion on this topic. Level of evidence:level I (systematic review and meta analysis)

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Intravenous tranexamic acid reduce postoperative drainage and pain after open elbow arthrolysis: a randomized controlled trial

Cited by 9 publications

References 26 publications

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

Does Tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

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